tbuckley/cabot-search huggingface dataset:
Abstract 13921: Substance Use Disorders and Prevalence of Stroke Amongst the US Population
Authors: Urvish Patel, Dr.Krishna Tavrawala, Zeeshan Mohammad, Anjali N Krishnakumar, Anitta Varghese, Maria Sneha Ashwini, Tanvi R Prabhu, Sushmita Patil, Tanvi Yogesh Shrivastav, sushil kumar, Baris Tarimci, Nikhila Chelikam, Shamik Shah
Journal: Circulation (2022)

Introduction: Globally, stroke is one of the top five leading causes of death. Although it was being mostly reported in the elderly population, recently a significant number of young adults are being diagnosed with stroke. The increasing prevalence of comorbidities like diabetes, &amp; hypertension, along with a rise in substance use disorders (SUDs) could be attributed to increased stroke diagnosis among young adults. Aims &amp; Objectives: The aims of the study include an evaluation of the prevalence of stroke in the US population &amp; prevalence of SUDs amongst patients with a history of Stroke. Methods: Our population was obtained from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. We identified respondents who were diagnosed with stroke &amp; SUDs based on the questionnaire. We performed univariate analysis using chi-square &amp; Mann-Whitney tests using SAS software (Version 9.4). A p-value of &lt;0.05 was considered statistically significant. Results: 264,740 respondents were included in this study, of which 10435 (3.94%) had a history of stroke. Respondents with history of stroke were older (median age: 68 years) &amp; more prevalent among males (3.98% vs 3.90% females), non-Hispanic Blacks (5.07% vs 4.76% non-Hispanic Whites vs 2.92% other Hispanics), population, &amp; those belonging to lower annual household income (6.76% $0-$25,000 vs 1.50% &gt;$100,000).(p&lt;0.0001). Consumption of cocaine [89.91% vs 95.56%], marijuana/hashish [63.72% vs 52.97%], methamphetamine [45.81% vs 39.71%], alcohol use disorder-heavy drinking [36.44% vs 47.21%], heroin [23.43% vs 15.21%], e-cigarettes [12.71% vs 17.09%], &amp; injectable drugs [4.21% vs 2.49%] were prevalent amongst people had stroke in comparison to without stroke history. Conclusions: The use of marijuana was most prevalent among respondents with a history of stroke followed by the use of methamphetamine &amp; heroin. With the legalization of marijuana in 19 states for recreational use, the government should plan appropriate policies to lessen the stroke burden among the population with SUDs in the USA. Recall bias &amp; geographic variations in response rate by participants of the study were the limitations of our survey-based study.
Abstract 14024: Role of Endothelial CXCR4 on the Development of Aortic Valve Stenosis
Authors: Anna Winnicki, James Gadd, Vahagn A Ohanyan, Gilbert Hernandez, Yang Wang, Molly Enrick, Hannah McKillen, Matthew Kiedrowski, Karlina Kegecik, Marc S Penn, William M Chilian, Liya Yin, Feng Dong
Journal: Circulation (2022)

Background. CXCL12/CXCR4 signaling is essential in cardiac development and repair, however, its contribution to the Aortic valve stenosis (AVS) remains unclear. In this study, we tested the role of endothelial CXCR4 on the development of AVS. Methods. We generated CXCR4 endothelial cell-specific knockout mice (EC CXCR4 KO) by crossing CXCR4 fl/fl mouse with Tie2-Cre mouse to study the role of endothelial cell CXCR4 in AVS. CXCR4 fl/fl mice with no Tie2-Cre gene present were used as control. Echocardiography was used to assess the aortic valve and cardiac function. Heart samples containing the aortic valve were stained using Alizarin Red for detection of calcification. Masson’s Trichrome staining was used for the detection of fibrosis. Apex samples were stained with wheat germ agglutinin to visualize ventricular hypertrophy. Results. Compared with the control group, the deletion of CXCR4 in endothelial cells led to significantly increased aortic valve peak velocity and aortic valve peak pressure gradient, and decreased aortic valve area and ejection fraction. EC CXCR4 KO mice also developed cardiac hypertrophy evidenced by increased left ventricular mass, diastolic and systolic left ventricle posterior wall (LVPW), cardiac myocyte size, and heart weight (HW) to body weight (BW) ratio. Our data also confirmed increased microcalcifications, interstitial fibrosis, and thickened valvular leaflets of the EC CXCR4 KO mice. Conclusions. We found that the deletion of CXCR4 in endothelial cells leads to aortic valve stenosis and left ventricular hypertrophy. This indicates endothelial cell CXCR4 plays a protective role against AVS, and EC CXCR4 KO mice can be used as a novel model for AVS study.
Abstract 13986: Efficacy and Safety of Cangrelor in Patients Undergoing PCI After Cardio-Pulmonary Resuscitation and/or Cardiogenic Shock. Results of the CAN-SHOCK Registry
Authors: Uwe Zeymer, Tobias Geisler
Journal: Circulation (2022)

Background. Cangrelor is an intravenous P2Y12 inhibitor with an immediate onset of action and a short half-life. Its use seems especially attractive in patients who cannot swallow oral drugs, e.g. after CPR or in cardiogenic shock. Purpose. To determine the efficacy and safety of the intravenous P2Y12 inhibitor cangrelor undergoing PCI after prehospital cardiopulmonary resuscitation (CPR) and/or cardiogenic shock (CS) in real life. Methods: The CAN-SHOCK registry included patients undergoing PCI for acute myocardial infarction after CPR. Baseline characteristics, procedural features, and in-hospital outcomes were centrally collected and analysed. The primary endpoint was the incidence of stent thrombosis and/or myocardial reinfarction until 48 hours after PCI. Results. A total of 303 patients were included in 10 centers in Austria and Germany. The inclusion criteria were CPR before PCI (n=169, 55.8 %), cardiogenic shock (n=68, 22.4 %) and CPR and cardiogenic shock (n=59, 19.5 %). The baseline characteristics, in-hospital procedures and outcomes are listed in the table. Conclusions. In this large multicentre registry cangrelor in patients undergoing PCI after CPR and/or CS cangrelor was effective in preventing stent thrombosis and re-infarction and associated with an acceptable bleeding rate.
Abstract 14321: The Role of the Sigma-2 Receptor in Myocardial Ischemia-Reperfusion Injury
Authors: Radhika Rastogi, Jing Li, Katherine Marsh, Aimee Zhang, Lian-Wang Guo, Zequan Yang
Journal: Circulation (2022)

Introduction: Pharmacological studies have identified two subtypes of sigma receptors, which are now known to be encoded by different genes. Activation of the sigma-1 receptor (S1R) is reported to protect the heart against myocardial ischemia-reperfusion injury (IRI). The role of sigma-2 receptors (S2R) in myocardial IRI remains unknown. Hypothesis: We hypothesize that inhibition of S2R attenuates myocardial IRI. Methods: C57BL/6 (WT) and congenic S2R knockout (KO) mice underwent 40 minutes of left coronary artery (LCA) occlusion followed by 60 minutes of reperfusion (40’/60’ IR). At the end of reperfusion, the hearts were harvested for TTC-Phthalo-blue staining to calculate infarct size (IS), denoted as a percentage of the ischemic risk region (RR). S1R agonist, PRE-084, and S2R antagonist, CM-398, were administered before LCA occlusion. Two other groups of WT mice underwent 30 minutes of LCA occlusion followed by 60 minutes of reperfusion (30’/60’ IR), with one control group and another treated with S2R agonist, Z485, prior to LCA occlusion. Results: In mice undergoing 40’/60’ IR, ischemic risk regions (RR, % of LV mass) were comparable among all groups. Infarct size (IS, % of RR) was 53±3% in control mice. Both the S1R agonist and S2R antagonist significantly reduced the IS to 37±4% and 38±2%, respectively ( p &lt;0.05 vs. control). S2R KO mice had significantly smaller IS (32±4% vs. control, p &lt;0.05. Figure Panel A). In mice undergoing 30’/60’ IR, ischemic risk regions were comparable among the 2 groups, but IS was significantly exacerbated in the S2R agonist-treated group (42±2% vs. control 25±4%, p &lt;0.05. Figure Panel B). Conclusion: Contrary to the effect of S1R, activation of S2R during myocardial IRI aggravated infarct size. Inhibition of S2R exerts an infarct-sparing effect. This pathway presents a new potential therapeutic target to attenuate myocardial IRI.
Abstract 14299: In-Hospital Outcomes of Patients With Obstructive Sleep Apnea Undergoing Atrial Septal Defect Repair
Authors: Sukhpreet Kaur, Bertrand Ebner, Michael Dangl, michael Albosta, Ian Ergui, Karla Inestroza, Rafael J Hernandez, Carlos Vergara-Sanchez, Jennifer Maning, LOUIS VINCENT, Jelani Grant, Rosario Colombo, Eduardo de Marchena
Journal: Circulation (2022)

Introduction: There is emerging new evidence of an association of atrial septal defects (ASD) with hypoxic conditions such as obstructive sleep apnea (OSA). In this study, we determined in-hospital outcomes of patients with OSA undergoing percutaneous ASD repair (ASDR). Methods: The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with and without a history of OSA with a primary diagnosis of ASD who underwent ASDR (Surgical or percutaneous) on the index admission. Logistic-regression was performed to adjust for pre-specified co-variable for different outcomes. p-value was considered significant when &lt;0.001. Results: We identified a weighted sample of 132,221 patients (≥18 years old) with a primary diagnosis of ASD, out of whom 10.9% (14,457) had ASDR. Of patients who underwent ASDR, 11.2% (1,615) carried a diagnosis of OSA. Baseline characteristics are shown in Table 1. There was no statistically significant difference in all-cause mortality between patients who underwent ASDR, with and without OSA (2.7% vs 2.7%). After adjusting for potential confounders, there was no statistical difference between both groups’ in-hospital outcomes such as total cost, length of stay, acute renal failure, stroke rate, vascular or pericardial complications. Conclusions: Although patients with OSA who underwent ASD repair have higher co-morbidities, they were not at higher risk for inpatient complications post-procedure and there was no difference in mortality noted. Prospective studies are needed to further investigate the effect of ASDR in OSA patients.
Abstract 14830: Comparative Cost-Effectiveness of Cardioprotective Glucose-Lowering Therapies for Type 2 Diabetes in a Middle-Income Country: A Bayesian Network Model
Authors: Luiz Sergio F Carvalho, Ana Claudia C Nogueira, Joaquim B Antunes, Filipe A Moura, Beatriz Luchiari, Isabella Bonilha, Wilson Nadruz, Michael Gaziano, Thomas Gaziano, Andrei Sposito
Journal: Circulation (2022)

Introduction: Unprecedented economic and social burden has expanded with the steady increase in Type 2 Diabetes (T2D) prevalence, particularly in low- and middle-income countries. Hypothesis: We hypothesize that novel anti-diabetic therapies such as SGLT2i or GLP1-RA would figure as more cost-effective among T2D subjects. Methods: Electronic databases were searched between August and April 2021. Inclusion criteria were: randomized clinical trials with T2D; articles published in English; double-blind, phase 3 or 4 trials; ≥100 patients per arm; follow-up &gt;24 weeks; and the pre-specified endpoints: death from any cause, major adverse cardiovascular events, and hospitalization for heart failure. Two prospective cohorts of T2D patients were used to feed the Markov Influence Diagram transition probabilities. Bayesian Networks and Markov Influence Diagram were used to estimate the incremental cost-effectiveness ratios (ICER) per disease-adjusted life years [DALYs] averted. The perspective of the Brazilian public health system was considered for costs and values were converted to international dollars (Int$). Results: We selected a total of 157 trials generating a sample size of 684,389 patient-years. Modeling was based on a primary and secondary prevention cohort of 851 and 1,337 patients, respectively. SGLT2i [HR:0.81 (95%CI: 0.69; 0.96)], GLP-1RA [HR:0.79 (95%CI: 0.67; 0.94)], and pioglitazone [HR:0.73 (95%CI: 0.59; 0.91)] reduced the relative risk of non-fatal cardiovascular events. In primary prevention, pioglitazone resulted in 0.2339 DALYs averted, with ICER of Int$7,082 (95%CI: 4,521; 10,770) per DALY averted, when compared to standard care. SGLT2i and GLP-1RA also increased the effectiveness (0.261 and 0.259 DALYs averted, respectively) but with higher ICERs [Int$12,061 (95%CI: 7,227; 18,121) and Int$29,119 (95% CI:23,811; 35,367) per DALY averted, respectively]. In secondary prevention, the three classes were cost-effective at a maximum willingness to pay threshold of Int$26,700. In both scenarios, however, pioglitazone had the highest probability of being cost-effective. Conclusions: In a middle-income country, pioglitazone presented a higher probability of being cost-effective followed by SGLT2i and then GLP-1RA.
Abstract 12999: Persistent Left Superior Vena Cava Draining Directly Into Left Atrium With Occluded Coronary Sinus: A Rare Incidental Finding
Authors: David Hana, Tyler C Miller, Madhavi Kadiyala, David Schwartzman, Christopher Mascio, Yasmin Hamirani
Journal: Circulation (2022)

Case presentation: A 43-year-old lady with pacing induced cardiomyopathy presented for pacemaker (PM) revision to biventricular PM. Medical history included complete heart block with dual-chamber PM, supraventricular tachycardia, and ventricular septal defect repair. During the procedure, numerous unsuccessful attempts were made to access the right atrium (RA) using a deflectable catheter through the left subclavian vein. Left upper extremity venography exhibited a persistent left superior vena cava (PLSVC) suspected to be entering RA through the coronary sinus (CS). Navigation of the CS was unsuccessful. As a result, the procedure was aborted, and the patient was admitted for further cardiac imaging evaluation. Transesophageal echocardiography demonstrated an abnormal blood vessel between left atrial appendage and left upper pulmonary vein. Findings confirmed with agitated saline injection into left arm. This rang a concern for unroofed coronary sinus. Surprisingly, cardiac computed tomography angiograms and left upper extremity venogram images revealed a PLSVC draining into left atrium (LA) posteriorly. Normal anatomy of the right-sided superior vena cava (RSVC). Also, a CS atresia and coronary venous drainage to LA inferiorly. Discussion: PLSVC is a rare cardiac anomaly with estimated prevalence of 0.2% - 3% among general population. Commonly PLSVC drains into RA through expanded CS and rarely into LA through unroofed CS. Uniquely like our patient, the PLSVC drains directly into the LA with atretic CS and no interatrial communication. PLSVC is usually asymptomatic and detected incidentally during invasive cardiac procedures. Despite existence of right to left shunt, patient was maintaining normal oxygen saturation even after a treadmill stress test. Crowdedness of the RSVC with previously implanted leads is likely the reason for failed passage of the catheter to RA. Cardiac arrhythmias and paradoxical embolization were reported with PLSVC.
Abstract 13675: Patient Awareness and Provider Counseling on Adverse Pregnancy Outcomes and Cardiovascular Risk - Insights From American Heart Association Research Goes Red Registry
Authors: Ellen Boakye, Yaa A Kwapong, Abha Khandelwal, Veronique L Roger, Pamela Ouyang, Pratheek Mallya, Juan Zhao, William Akel, Roger Blumenthal, Laxmi S Mehta, Jennifer L Hall, Garima Sharma
Journal: Circulation (2022)

Introduction: Adverse pregnancy outcomes (APOs) are associated with long-term cardiovascular (CV) risk. This study aimed to identify awareness of the association of APOs with CV risk among patients and to determine whether care providers assessed pregnancy history and counseled on the association of APOs with CV risk during patient visits. Methods: We used data from participants enrolled in the AHA Research Goes Red Registry, an online research platform powered by Verily, who responded to the Fertility and Pregnancy Survey. Among them, 1,499 were postmenopausal (mean age 54.7 ± 7.8 years). We focused on three specific questions related to the goals of this study. We summarized responses using proportions, for the overall sample and by race and income, and tested differences using the Chi-squared test. Significance was set at p&lt;0.05. Results: A total of 828 participants answered the question on awareness of the association of APOs with CV health. Of them, 35% were unaware of this association, with significant differences by race (p=0.019) ( Fig 1A ). Among 815 women who responded to the question on whether their care providers took pregnancy history during visits, 35% stated that their providers did not. The percentage varied significantly by income level, with highest percentage among women with an annual income &lt;$50,000 and the lowest in those with an income ≥$200,000 (p=0.037) ( Fig 1B ). Notably, pregnancy history was not taken by providers in 1 in 2 Asian women ( Fig 1C ). Among 813 women who answered the question on provider counseling on the association of APOs with CV risk, 71% reported that their care providers did not educate them on this association, with no significant differences by race or income. Conclusions: In this contemporary cohort, considerable knowledge gaps exist on the association of APOs with CV risk, with disparities by race. Also, most women are not educated on this association by their care providers. These data suggest the need for more education on APOs and CV.
Abstract 13112: Theranostic Properties of Porphysome Nanoparticles in Atherosclerotic Cardiovascular Disease
Authors: Victoria A Nankivell, Achini Vidanapathirana, Maneesha Rajora, Peter Psaltis, Joanne T Tan, William Tieu, Gang Zheng, Christina A Bursill
Journal: Circulation (2022)

Introduction: ‘Porphysome’ nanoparticles contain porphyrin-lipid which permits fluorescent imaging and can be radiolabelled for positron emission tomography (PET) imaging. The outer shell contains the R4F peptide that interacts with scavenger receptor SR-B1, enabling macrophage targeting and therapeutic effects. Aim: To investigate anti-atherosclerotic and imaging properties of porphysomes. Methods: In vitro, porphysome or PBS-treated macrophages were assessed for uptake (fluorescence microscopy), [ 3 H]-cholesterol efflux and inflammatory responses following lipopolysaccharide stimulation (qRT-PCR/ELISA). In vivo, high-fat diet (HFD) fed apolipoprotein ( Apo)e -/- mice were infused for 8 weeks with porphysomes (3x/week, 40mg/kg) or PBS. 64 Cu-porphysomes were detected by fluorescence (IVIS)/PET imaging. Aortas were digested for flow cytometry. Results: In vitro , porphysomes were internalised by macrophages and increased cholesterol efflux (80%, P &lt;0.05), compared to PBS controls. Porphysomes reduced macrophage mRNA levels of inflammatory factors Il-1β (88%), Il-18 (54%) and Ccl5 (75%), and protein secretion of IL-1β (69%) and CCL5 (82%), P &lt;0.05. Porphysomes suppressed inflammasome components Rela (38%), Nlrp3 (69%) and Asc (36%), P &lt;0.05. In Apoe -/- mice, porphysomes were detected in aortic sinus plaque by fluorescence, co-localised with CD68 + macrophages, and by IVIS in aortic arch plaque, with higher fluorescence intensity in HFD (55%) than chow-fed mice. PET imaging found porphysomes localised in hearts. Porphysome uptake was higher in aortic macrophages than endothelial (9-fold) or smooth muscle (4.5-fold) cells ( P &lt;0.05). Porphysome-treated mice had less aortic macrophages (49%) of the M2-like phenotype (60%), than PBS controls. Conclusions: Porphysomes exhibit multi-modal imaging capabilities for identifying plaque and have athero-protective properties, demonstrating theranostic potential for atherosclerosis.
Abstract 13893: Higher Social Vulnerability Index is Associated With Higher Risk of Mortality Following Acute Myocardial Infarction in the USA
Authors: Muchi Ditah Chobufo, Ebad Rahman, Ndip Agbor, yasar sattar, Anas Alharbi, Karthik Gonuguntla, Yolande Mbome, sudarshan balla
Journal: Circulation (2022)

Introduction: Timely management of acute myocardial infarction (AMI) significantly improves outcomes. Patient and community-level characteristics are strong determinants of survival following AMI. The Social Vulnerability Index(SVI) is a robust community assessment tool that reliably ranks counties based on several parameters on a scale from 0 to 1. More vulnerable communities have higher SVI scores. Hypothesis: Higher levels of SVI scores will be associated with higher AMI-related deaths in the USA. Methods: Using the multiple causes of death database from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research(1999-2020), we extracted county-level deaths with any mention of AMI with ICD-10 codes I21 and I22. County-level SVI was obtained from CDC/ATSDR. We fitted segmented regression models to evaluate the association between quintiles of SVI scores and AMI-related age-adjusted mortality rate (AAMR, expressed per 100,000 persons). Analysis was done using STATA v17 and Joinpoint segmented regression softwares with p-values &lt;0.05 considered statistically significant. Results: The AMI-related AAMR was 52.4 per 100,000 (95% CI 52.4 - 52.5) for the entire USA, decreasing from 87.4 (95% CI: 87.0 - 87.7) in 1999 to 38.2 (95% CI:38.0 - 38.4) in 2020. On average, each unit increase in SVI quintile was associated with a 12.5% higher AMI-related AAMR (beta=12.4%, 95% CI: 8.9 - 16.0, p=0.001), Figure 1. Conclusions: More vulnerable counties are associated with higher risk of AMI-related deaths. Further research is needed to identify and address the driving factors so as to reduce this disparity.
Abstract 13844: Comprehensive Proteomics Profiling of Myocardium Identifies Dysregulated Signaling Pathways in Hypertrophic Cardiomyopathy
Authors: Heidi S Lumish, Lusha Liang, Kohei Hasegawa, Elizabeth Adlestein, Daniel Swistel, Mathew S Maurer, Muredach P Reilly, Mark Sherrid, Yuichi J Shimada
Journal: Circulation (2022)

Background: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease. The signaling pathways that link gene mutations to the manifestation of clinically-overt HCM remain unknown. Hypothesis: Comprehensive proteomics profiling of myocardium identifies signaling pathways that are differentially regulated in HCM. Methods: We conducted a multicenter case-control study. Cases were patients with HCM who underwent septal myectomy. Controls were donors without cardiac disease whose heart was excised but could not be transplanted due to size mismatch. We performed proteomics profiling of 7289 proteins from myocardium and excluded 1222 proteins significantly correlated with age. We performed a univariable analysis of the remaining 6067 proteins to determine the association between protein concentration and disease status using the Wilcoxon rank sum test. We executed pathway analysis of proteins significantly dysregulated (i.e., univariable p &lt;0.05) in cases with HCM compared to controls. Pathways with false discovery rate [FDR] &lt;0.01 were considered to be dysregulated. Results: There were 121 patients included in the study, with 106 HCM cases and 15 controls. Among the 6067 proteins analyzed, 986 were differentially regulated between HCM cases and controls. Pathway analysis of these proteins revealed dysregulation of the Ras-MAPK pathway (FDR &lt; 0.0001) and multiple metabolic pathways, mainly related to amino acid metabolism ( Figure ). Pathways that are known to be dysregulated in HCM, such as the TNF pathway and those related with inflammation, were also dysregulated. Conclusions: The present study represents the largest-scale (n &gt;100) and most comprehensive proteomics profiling (&gt;7000 proteins) of human HCM myocardium to date, elucidating dysregulation of both novel (e.g., Ras-MAPK, amino acid metabolism) and known (e.g., TNF, inflammation) pathways in patients with HCM.